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Prevention and screening

In most people who develop diabetes there is a hereditary (genetic) component. However, in nearly all cases the genetic component alone does not cause the diabetes, but interactions with the environment of a person who is genetically susceptible. This is clearly demonstrated by the epidemic of diabetes worldwide. The dramatic increase in figures clearly cannot be accounted for by genetic factors. However, without the genetic susceptibility modern lifestyle changes would have no fertile field on which to exert their dangerous influences.

Among the most feared diabetes complications are those affecting the eyes. Indeed, diabetes is the leading cause of partial vision loss and blindness in the working age population in many countries. The good news is that it does not have to be so.

Diabetes UK worked hard to influence the content of the National Service Framework (NSF) from the moment it was first announced by the then UK Health Secretary Frank Dobson in 1999. Indeed, we perceived the announcement of the NSF as a victory in itself – recognition at last that diabetes is a serious condition with major implications for the 1.4 million already diagnosed as well as those yet to be diagnosed. The long wait inevitably resulted in high expectations. However, many were not surprised when the government did not meet these expectations in their entirety.

Martin Kent is a general practitioner with a special interest in the management and care of people with diabetes, and a clinical advisor in diabetes to the local Primary Care Trust (PCT). Matt Rangué is the Associate Director of Nursing & Clinical Governance to the Trust, with responsibility for workforce development, training and quality in the delivery of the new UK Diabetes National Service Framework (NSF). Martin and Matt see the UK Diabetes NSF as a valuable tool around which to plan and deliver services to people with diabetes.

Overweight is an important risk factor for noncommunicable diseases in general and diabetes in particular. There is presently a global epidemic of overweight. A recent large study found a 5.6% growth in obesity in the United States in 2001, and a massive 74% increase since 1991. Twenty one percent of American adults are obese. The prevalence of diabetes, which correlates with obesity has risen 61% in the US since 1990. Diabetes rose 8% over 2000-01 to nearly 8% of the population. The situation is not much better in many developing countries.

Obesity is an epidemic accelerating out of control. It is the driving force behind an equally dramatic explosion of Type 2 diabetes, both in adults and now alarmingly among children. Clearly, strategies aimed at improving the prevention and management of obesity must be developed. Not confined to affluent nations, the obesity epidemic imposes a double burden on countries where people are still struggling to overcome generations of chronic undernutrition. Economic progress in developing countries heralds changes in

As prevalence of diabetes increases globally, developing countries such as India face the massive burden of a diabetes epidemic in the urban population. Migrant Asians from the Indian subcontinent are known to have a higher prevalence of Type 2 diabetes than the host populations and other migrant ethnic groups. Studies conducted in several Asian countries in the last decade highlighted a rising prevalence of Type 2 diabetes in the urban population. The prevalence of impaired glucose tolerance (IGT) is also on the rise, indicating a possible further increase in diabetes in the future.

Were there warnings that diabetes would become the epidemic of the 21st century? In the early 1970s, Peter Bennett and co-workers reported on the extraordinarily high prevalence of Type 2 diabetes in Pima Native Americans. In 1975, we reported the high rates of diabetes in the Micronesian Nauruans in the Pacific. Similar findings followed in other Pacific and Asian island
populations. They all indicated the potential for a future global epidemic.

Even among policy makers at an international and national level, awareness about the public health and clinical importance of diabetes remains low. Diabetes is widely perceived as a condition of low importance to the poorer populations in the world. In the low- and middle-income countries, the impact of diabetes is largely unrecognized. Yet the world is facing a dramatic rise in diabetes prevalence, most of which will occur in the low- and middle-income countries.